What are the risk factors for Coronary Artery Disease (CAD)?

From the Guidelines

Risk factors for coronary artery disease (CAD) include both modifiable and non-modifiable factors that increase one's likelihood of developing atherosclerosis and subsequent heart disease. The major modifiable risk factors include smoking, which damages blood vessel walls and accelerates atherosclerosis; hypertension, which strains the heart and blood vessels; dyslipidemia, particularly elevated LDL cholesterol and low HDL cholesterol; diabetes mellitus, which accelerates vascular damage; obesity, especially central adiposity; physical inactivity; and poor diet high in saturated fats and processed foods. Non-modifiable risk factors include advancing age, with risk increasing significantly after age 45 for men and 55 for women; male gender, though risk equalizes after menopause; family history of premature CAD; and certain ethnicities, with South Asians having particularly high risk 1. Other contributing factors include chronic stress, excessive alcohol consumption, and certain inflammatory conditions. The risk of CAD increases substantially when multiple risk factors are present, as they tend to have synergistic effects on vascular damage. Addressing modifiable risk factors through lifestyle changes and appropriate medical therapy remains the cornerstone of CAD prevention, as supported by the 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction 1.

Some key points to consider:

• The presence of multiple risk factors can significantly increase an individual's risk of developing CAD, and addressing these factors through lifestyle changes and medical therapy is crucial for prevention 1.
• The detection of subclinical atherosclerosis by noninvasive imaging can help refine individual risk assessment and guide treatment decisions 1.
• Certain populations, such as those with a family history of premature CAD or certain ethnicities, may be at higher risk for developing CAD and should be targeted for aggressive risk factor modification 1.
• The use of risk prediction tools, such as the Framingham equations, can help estimate an individual's 10-year and lifetime risk of developing CAD and guide treatment decisions 1.

Overall, a comprehensive approach to CAD prevention should include identification and management of modifiable risk factors, as well as consideration of non-modifiable risk factors and other contributing factors.

From the Research

Risk Factors for Coronary Artery Disease (CAD)

The following are some of the key risk factors for CAD:

• Modifiable risk factors:
  • High blood pressure (hypertension) 2
  • High cholesterol (hyperlipidemia) 3, 4
  • Smoking 3, 4, 5
  • Diabetes mellitus 4, 5
  • Obesity 4, 5
  • Physical inactivity 5
  • Poor diet 5
• Non-modifiable risk factors:
  • Age 2
  • Family history of CAD 4
  • Genetic factors (e.g. chromosome 9p21.3) 4

Management of Risk Factors

Managing modifiable risk factors can help reduce the risk of CAD:

• Lifestyle changes:
  • Quitting smoking 3, 5
  • Increasing physical activity 5
  • Eating a healthy diet 5
  • Losing weight (if obese) 4, 5
• Medications:
  • Antiplatelet agents (e.g. aspirin) 6
  • Statins (to lower cholesterol) 3, 6
  • Blood pressure-lowering agents (e.g. beta blockers) 6, 2
  • Anti-inflammatory agents (e.g. for patients with high C-reactive protein levels) 5

Treatment Goals

The primary goal of treatment is to reduce the risk of CAD events:

• Blood pressure targets: <140/90 mmHg 2
• Cholesterol targets: lowering LDL-cholesterol levels 3
• Antiplatelet therapy: using aspirin or other antiplatelet agents 6